Transsexualism describes the condition in which an individual identifies with a gender inconsistent or not culturally associated with their assigned sex, i.e. in which a person's assigned sex at birth conflicts with their brain sex. A medical diagnosis can be made if a person experiences discomfort as a result of a desire to be a member of the opposite gender,[1] or if a person experiences impaired functioning or distress as a result of that gender identification.[2]

Transsexualism is stigmatized in many parts of the world but has become more widely known in Western culture in the mid to late 20th century, concurrently with the sexual revolution and the development of sex reassignment surgery (SRS). Discrimination or negative attitudes towards transsexualism often accompany certain religious beliefs or cultural values.

There are cultures that have no difficulty integrating people who change gender roles, often holding them with high regard, such as the traditional role for "Two-Spirit" people found among certain Native American tribes.[3]

A desire or insistence that one is of the opposite biological sex (that is not due to a perceived advantage of being the other sex)

Evidence of persistent discomfort with, and perceived inappropriateness of the individual's biological sex

The individual is not intersex (although a diagnosis of GID Not Otherwise Specified is available, which enables intersex people who reject their sex-assignment to access transsexual treatments)

Evidence of clinically significant distress or impairment in work or social life.

Process

Template:Refimprove section
The current diagnosis for transsexual people who present themselves for psychological treatment is "gender identity disorder" (leaving out those who have sexual identity disorders without gender concerns). The DSM changed its terminology in 1994 away from the diagnosis of "transsexualism". According to the Standards Of Care formulated by the World Professional Association for Transgender Health (WPATH),[6][7] formerly the Harry Benjamin International Gender Dysphoria Association, this diagnostic label is often necessary to obtain sex reassignment therapy with health insurance coverage, and states that the designation of gender identity disorders as mental disorders is not a license for stigmatization, or for the deprivation of gender patients' civil rights. However, some people diagnosed with gender identity disorder have no desire for sex reassignment therapy at all, particularly not genital reassignment surgery, and/or are not appropriate candidates for such treatment. While some feel that formal diagnosis helps to destigmatize transsexualism, others feel that it only adds stigma, essentially feeling that such a diagnosis is equivalent to saying something really is wrong with transsexual people. The diagnosis of "gender identity disorder" is seen as insulting and irrelevant to some transsexual people, and may be considered a causal factor in instances of harm occurring to, or death of, transsexual people as the result of prejudice and discrimination when deprived of their civil rights. (Brown 105)

Transsexual people may refer to themselves as trans men or trans women. Transsexual people often desire to establish a permanent gender role as a member of the gender with which they identify. Some transsexual people pursue medical interventions as part of the process of expressing their gender.

Not all transsexual people undergo a physical transition. Some find reasons not to, for example, the expense of surgery, the risk of medical complications, medical conditions which make the use of hormones or surgery dangerous. Some may not identify strongly with another binary gender role. Others may find balance at a mid-point during the process, regardless of whether they are binary-identified. Many transsexual people, including binary-identified transsexual people, do not undergo genital surgery, because they are comfortable with their own genitals, or because they are concerned about nerve damage and the potential loss of sexual pleasure and orgasm. This is especially so in the case of trans men, many of whom are dissatisfied with the current state of phalloplasty, which is typically very expensive, not covered by health insurance, and which does not result in a fully erectile, sexually sensate penis.

Some transsexual people live heterosexual lifestyles and gender roles, while some identify as gay, lesbian,[11] or bisexual. Many trans people find that a shift occurs in their sexual orientation as they undergo transition. Many transsexual people choose the language of how they refer to their sexual orientation based on their gender identity, not their morphological sex,[11] though some transsexual people still find identification with their community: many trans men, for instance, are involved with lesbian communities, and identify as lesbian despite their male identity. Some lesbians are willing to become sexually or romantically involved with trans men; some gay men are willing to do the same with trans women; where both groups typically would not date members of the opposite sex.

Origins

Gender was originally a linguistic term. In many languages, words can be considered masculine, feminine, or neutral, completely independently from the attributes of the things to which the word applies. Different languages manifest gender in various ways, recognizing two genders (female, male), three genders (female, male, neuter), or in some cases none at all. In some (e.g. the Romance languages), variation by gender is indicated by relatively simple changes in nouns and adjectives, while others require more complex grammatical changes. In English, a transsexual person's first step in transition often includes the request to be referred to using pronouns for their target gender (she rather than he, her rather than him, and hers rather than his, or vice versa). Some English speakers [attribution needed] who feel that they are best described as something in between or other than masculine or feminine prefer to use "they" and "them", as well as “ze” and “hir” (examples of gender-neutral pronouns in English) or other invented neutral pronouns.[12]

Norman Haire reported that in 1921,[13] that Dora-R of Germany under the care of Magnus Hirschfeld, began surgical transition from 1921, ending in 1930 with a successful genital reassignment surgery.
In 1930, Magnus Hirschfeld supervised the second genital reassignment surgery to be reported in detail in a peer-reviewed journal on Lili Elbe of Denmark. The German term “Transsexualismus” was introduced by Hirschfeld in 1923.[14] The neo-Latin term “psychopathia transexualis” and English “transexual” were introduced by D. O. Cauldwell in 1949,[15] who subsequently also used the term “trans-sexual” in 1950.[16] Cauldwell appears to be the first to use the term in direct reference to those who desired a change of physiological sex.[17] (In 1969, Benjamin claimed to have been the first to use the term “transsexual” in a public lecture, which he gave in December 1953.[18]) This term continues to be used by the public and medical profession alike.[19] It was included for the first time in the DSM-III in 1980 and again in the DSM-III-R in 1987, where it was located under Disorders Usually First Evident in Infancy, Childhood or Adolescence.

The word transsexual was used by Harry Benjamin in his seminal 1966 book The Transsexual Phenomenon to describe transsexual people on a scale (later called the "Benjamin scale") that recognizes three levels of intensity of transsexualism: "Transsexual (nonsurgical)", "Transsexual (moderate intensity)", and "Transsexual (high intensity)".[20][21][22] in The Transsexual Phenomenon, Benjamin described "true" transsexualism in this way: "True transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such. For them, their sex organs, the primary (testes) as well as the secondary (penis and others) are disgusting deformities that must be changed by the surgeon's knife."[23] Benjamin suggested that moderate intensity male to female transsexual people may benefit from estrogen medication as a "substitute for or preliminary to operation."[20] Some people have had SRS but do not meet the common definition of a transsexual (e.g., Gregory Hemingway).[24][25] Other people do not desire SRS although they do meet Dr. Benjamin's definition of a "true transsexual".[26] Beyond Benjamin's work, which focused on male-to-female transsexual people, there is the case of the female to male transsexual for whom genital surgery may not be practical. Benjamin gives his MTF transsexual patients papers that will help with most legal problems. The certificates state 'Their anatomical sex, that is to say, the body, is male. Their psychological sex, that is to say, the mind, is female'. However, beyond 1967 Benjamin and his terminology of sexual identity are found to be mostly obsolete.[11]

Relation to transgenderism

Transsexualism is often included within the broader category of transgenderism, which is generally used as an umbrella term for people who do not conform to typical accepted gender roles, for example cross-dressers, transvestites, and people who identify as genderqueer. Transsexualism refers to a specific condition in the transgender realm. Thus, even though a crossdresser and transsexual are both transgender people, their conditions differ radically.[27][28] Though some people use transgenderism and transsexualism interchangeably, they are not synonymous terms.[29]

Some transsexual people object to being included in the transgender spectrum; anthropologist David Valentine contextualizes the objection to including transsexual people in his book "Transgender, an Ethnography of a Category."[30] He writes that transgender is a term coined and used by activists to include many people who do not necessarily identify with the term. He observes that many current health clinics and services set up to serve gender variant communities employ the term, but that most of the service-seekers do not identify with the term. The rejection of this political category, first coined by self-identified activist Leslie Feinberg, illustrates the difference between a self-identifier and categories imposed by observers to understand other people.[31]

Historically the reason that transsexual people rejected associations with the transgender or broader LGBT community is largely that the medical community in the 1950s through the late 1980s encouraged this rejection of such a grouping in order to qualify as a 'true transsexual' who would thus be allowed to access medical and surgical care. The animosity that is present today is no longer fed by this same kind of pressure from the medical community.[citation needed]

Though the beliefs of some modern day transsexual people that they are not "transgender" reflects this historical division (Denny 176), other transsexual people state that those who do not seek SRS are very different from those who need to be of "the other sex", and that these groups have different issues and concerns and are not doing the same things.[22] The latter view is rather contested, with opponents pointing out that merely having or not having some medical procedures hardly can have such far-reaching consequences as to put those who have them and those who have not into such distinctive categories. Notably Harry Benjamin's original definition of transsexualism does not require that they need to have had SRS.[20]

Terminology

The word "transsexual" is most often used as an adjective rather than a noun – a "transsexual person" rather than simply "a transsexual". Transsexual people prefer to be referred to by the gender pronouns and terms associated with their target gender. For example, a transsexual man is a person who was assigned the female sex at birth on the basis of his genitals, but despite that assignment identifies as a man and is transitioning or has transitioned to a male gender role and has or will have a masculine body. Transsexual people are sometimes referred to with "assigned-to-target" sex terms such as "female-to-male" for a transsexual man or "male-to-female" for a transsexual woman. These terms may be abbreviated as "M2F", "F2M", "MTF", "F to M", etc.

Alternative terminology

The term "gender dysphoria" and "gender identity disorder" were not used until the 1970s[19] when Laub and Fisk published several works on transsexualism using these terms.[32][33] "Transsexualism" was replaced in the DSM-IV by "gender identity disorder in adolescents and adults".

Prevalence

The DSM-IV (1994) quotes a prevalence of roughly 1 in 30,000 assigned males and 1 in 100,000 assigned females seek sex reassignment surgery in the USA. The most frequently quoted estimate of prevalence is from the Amsterdam Gender Dysphoria Clinic[34] The data, spanning more than four decades in which the clinic has treated roughly 95% of Dutch transsexual clients, gives figures of 1:10,000 assigned males and 1:30,000 assigned females. Though no direct studies on the prevalence of GID have been done, a variety of clinical papers published in the past 20 years provide estimates ranging from 1:7,400 to 1:42,000 in assigned males and 1:30,040 to 1:104,000 in assigned females.[35]

Olyslager and Conway presented a paper[36] at the WPATH 20th International Symposium (2007) arguing that the data from their own and other studies actually imply much higher prevalence, with minimum lower bounds of 1:4,500 male-to-female transsexual people and 1:8,000 female-to-male transsexual people for a number of countries worldwide. They estimate the number of post-op women in the US to be 32,000 and obtain a figure of 1:2500 male-to-female transsexual people. They further compare the annual incidences of SRS and male birth in the U.S. to obtain a figure of 1:1000 MTF transsexual people and suggest a prevalence of 1:500 extrapolated from the rising rates of SRS in the U.S. and a "common sense" estimate of the number of undiagnosed transsexual people.

Olyslager and Conway also argued that the U.S. population of assigned males having already undergone reassignment surgery by the top three U.S. SRS surgeons alone is enough to account for the entire transsexual population implied by the 1:10,000 prevalence number. This excludes all other U.S. SRS surgeons, surgeons in countries such as Thailand, Canada, and others, and the high proportion of transsexual people who have not yet sought treatment, suggesting that a prevalance of 1:10,000 is too low.

A study in 2008 examined the number of New Zealand passport holders who changed the sex on their passport and estimated that 1:3,639 birth-assigned males and 1:22,714 birth-assigned females were transsexual.[37]

A presentation at the LGBT Health Summit in Bristol, UK,[38] based upon figures from a number of reputable European and UK sources, shows that this population is increasing rapidly (14% per year) and that the mean age of transition is actually rising.

Causes

Psychological and biological causes for transsexualism have been proposed, i.a. by professor Dick Swaab, with evidence leaning toward prenatal and genetic causes.[39][40][41] One such proposed cause is related to the bed nucleus of a stria terminalis, or BSTc, a constituent of the basal ganglia of the brain which is affected by prenatal androgens.[42] In one study, the BSTc of male-to-female transsexual women was similar to those of cisgender women whose psychological gender identity and assigned sex are the same. However, those of both heterosexual and homosexual men were similar to each other but different from those of women (both cis- and transsexual).[40] Another study suggests that transsexuality may have a genetic component.[43] There is considerable evidence that prenatal exposure to endocrine-disrupting anti-miscarriage drugs such as diethylstilbestrol (DES) may also be positively associated with transsexualism, though research in this area has yet to establish a firm causal link.[44][45][46][47]

Some people consider research into the "causes" of transsexualism to be based on the assumption that it is a pathology, an assumption that is rejected by many transsexual people.[citation needed] Others think of the condition as a form of intersexuality, and support research into possible causes, believing that it will verify the theory of a biological origin and thereby reduce social stigma by demonstrating that it is not a delusion, a political statement, or a paraphilia. Note that social stigma has a role to play in the development of and adherence to both viewpoints. See the transfeminism article's section on GID for further discussion.

Harry Benjamin wrote, "Summarizing my impression, I would like to repeat here what I said in my first lecture on the subject more than 10 years ago: Our genetic and endocrine equipment constitutes either an unresponsive, sterile, or a more or less responsive, that is to say, fertile soil on which the wrong conditioning and a psychic trauma can grow and develop into such a basic conflict that subsequently a deviation like transsexualism can result."[48]

Sex reassignment therapy

Sex reassignment therapy (SRT) is an umbrella term for all medical treatments related to sex reassignment of both transgender and intersexual people. Though SRT is sometimes called "gender reassignment", those who use the word "sex" to describe an individual's biology and "gender" to describe their personal identity and social role consider this usage to be misleading. The process of changing from one gender presentation to another is often called transition.

To obtain sex reassignment therapy, transsexual people are generally required to undergo a psychological evaluation and receive a diagnosis of gender identity disorder in accordance with the Standards of Care (SOC) as published by the World Professional Association for Transgender Health.[6] This assessment is usually accompanied by counseling on issues of adjustment to the desired gender role, effects and risks of medical treatments, and sometimes also by psychological therapy. The SOC are intended as guidelines, not inflexible rules, and are intended to ensure that clients are properly informed and in sound psychological health, and to discourage people from transitioning based on unrealistic expectations.

Psychological treatment

Psychological techniques that attempt to alter gender identity to one considered appropriate for the person's assigned sex are typically ineffective. The widely recognized Standards of Care[7] note that sometimes the only reasonable and effective course of treatment for transsexual people is to go through sex reassignment therapy.[7][49]

The need for treatment is emphasized by the high rate of mental health problems, including depression, anxiety, and various addictions, as well as a higher suicide rate among untreated transsexual people than in the general population.[50] These problems may be alleviated by a change of gender role and/or physical characteristics.[51]

Many transgender and transsexual activists, and many caregivers, note that these problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-variant individuals. Some transsexual people reject the counseling that is recommended by the Standards of Care[7] because they don’t consider their gender identity to be a psychological problem.

Brown and Rounsley[52] noted that "[s]ome transsexual people acquiesce to legal and medical expectations in order to gain rights granted through the medical/psychological hierarchy." Legal needs such as a change of sex on legal documents, and medical needs, such as sex reassignment surgery, are usually difficult to obtain without a doctor and/or therapist's approval. Because of this, some transsexual people feel coerced into affirming outdated concepts of gender to overcome simple legal and medical hurdles (Brown 107).

Medical aspects

After an initial psychological evaluation, men and women may begin medical treatment starting with hormone replacement therapy[7][53] or hormone blockers. People who change sex are usually required to live as members of their target sex for at least one year prior to genital surgery, so-called Real-Life Experience (RLE) or Real-Life Test (RLT).[7] Transsexual individuals may undergo some, all, or none of the medical procedures available, depending on personal feelings, health, income, and other considerations. Some people posit that transsexualism is a physical condition, not a psychological issue, and assert that sex reassignment therapy should be given on request. (Brown 103)

Regrets and detransitions

People who undergo sex reassignment surgery can develop regret for the procedure later in life, largely due to lack of support from family or peers, with data from the 1990s suggesting a rate of 3.8%.[54] A review of Medline literature suggests the total rate of patients expressing feelings of doubt or regret is estimated to be as high as 8%.[55] In a 2001 study of 232 MTF patients who underwent GRS with Dr. Toby Meltzer, none of the patients reported complete regret and only 6% reported partial or occasional regrets.[56]

Legal and social aspects

Laws regarding changes to the legal status of transsexual people are different from country to country. Some jurisdictions allow an individual to change their name, and sometimes, their legal gender, to reflect their gender identity. Within the US, some states allow amendments or complete replacement of the original birth certificates.[59] Some states seal earlier records against all but court orders in order to protect the transsexual's privacy.

In many places, it is not possible to change birth records or other legal designations of sex, although changes are occurring. Estelle Asmodelle’s book documented her struggle to change the Australian birth certificate and passport laws, although there are other individuals who have been instrumental in changing laws and thus attaining more acceptance for transsexual people in general.

Medical treatment for transsexual and transgender people is available in most Western countries. However, transsexual and transgender people challenge the "normative" gender roles of many cultures and often face considerable hatred and prejudice. The film Boys Don't Cry chronicles the case of Brandon Teena, a transsexual man who was raped and murdered after his status was discovered. The project Remembering Our Dead, founded by Gwendolyn Ann Smith, archives numerous cases of transsexual and transgender people being murdered.[60] In the United States, November 20 has been set aside as the "Day of Remembrance" for all murdered transgender people.[61]

Some people who have switched their gender role enter into traditional social institutions such as marriage and parenting. They sometimes adopt or provide foster care for children, as complete sex reassignment therapy inevitably results in infertility. Some transsexual people have children from before transition. Some of these children continue living with their transitioning/transitioned parent, or retain close contact with them.

The style guides of many media outlets prescribe that a journalist who writes about a transsexual person should use the name and pronouns used by that person. Family members and friends, who are often confused about pronoun usage or the definitions of sex, are frequently instructed in proper pronoun usage, either by the transsexual person or by professionals or other persons familiar with pronoun usage as it relates to transsexual people. Sometimes, transsexual people have to correct their friends and family members many times before they begin to use the proper pronouns consistently. Deliberate mis-gendering is perceived to be a form of transphobia.

Both "transsexualism" and "gender identity disorders not resulting from physical impairments" are specifically excluded from coverage under the Americans with Disabilities Act Section 12211.[62]
Gender Dysphoria is not excluded.[63]

Coming out

Employment issues

Transsexual people can have difficulty maintaining employment. Most find it necessary to remain employed during transition in order to cover the costs of living and transition. However, employment discrimination against trans people is rampant and many of them are fired when they come out or are involuntarily outed at work.[64] Transsexual people must decide whether to transition on-the-job,[65] or to find a new job when they make their social transition. Other stresses that transsexual people face in the workplace are being fearful of coworkers negatively responding to their transition, and losing job experience under a previous name—even deciding which rest room to use can prove challenging.[66] Finding employment can be especially challenging for those in mid-transition.

Laws regarding name and gender changes in many countries make it difficult for transsexual people to conceal their trans status from their employers.[67] Because the Harry Benjamin Standards of Care require a one-year RLE prior to SRS, some feel this creates a Catch 22 situation which makes it difficult for trans people to remain employed or obtain SRS.

In many countries, laws provide protection from workplace discrimination based on gender identity or gender expression, including masculine women and feminine men. An increasing number of companies are including "gender identity and expression" in their non-discrimination policies.[59][68] Often these laws and policies do not cover all situations and are not strictly enforced. California's anti-discrimination laws protect transsexual persons in the workplace and specifically prohibit employers from terminating or refusing to hire a person based on their transsexuality. The European Union provides employment protection as part of gender discrimination protections following the European Court of Justice decisions in P v S and Cornwall County Council.[69]

In the National Transgender Transgender Discrimination Survey, 44% of respondents reported not getting a job they applied for because of being transgender.[70]
36% of trans women reported losing a job due to discrimination compared to 19% of trans men.[70]
54% of trans women and 50% of trans men report having been harassed in the workplace.[70] Transgender people who have been fired due to bias are more than 34 times likely than members of the general population to attempt suicide.[70]

Stealth

Some transsexual men and women choose to live completely as members of their target gender without being public about their past. This approach is sometimes called stealth. Some people feel that they have an obligation to be open about their past in order to further the cause of civil rights for LGBT people.

There are examples of people having been denied medical treatment upon discovery of their trans status, whether it was revealed by the patient or inadvertently discovered by the doctors.[71] For example, Leslie Feinberg was once turned away from a hospital emergency room where he had sought treatment for endocarditis.[72][unreliable source?]

Feinberg was presenting as a man but had female genital anatomy. He nearly died after being denied treatment. Feinberg's case demonstrates one of the many dangers of having one's trans status discovered. Tyra Hunter died after being denied care by paramedics and emergency room physicians after she was injured in an automobile accident.[71]

Before transsexual people were depicted in popular movies and television shows, Aleshia Brevard — an actual transsexual whose surgery took place in 1962 — was actively working as an actress and model in Hollywood and New York throughout the 1960s and '70s. Aleshia never portrayed a transsexual person, though she appeared in eight Hollywood produced films, on most of the popular variety shows of the day including The Dean Martin Show, and was a regular on The Red Skelton Show and One Life to Live before returning to University to teach Drama and Acting.[74][75]

Thomas Harris's Silence of the Lambs included a serial killer who considered himself a transsexual. After being turned down for sex reassignment surgery due to not meeting necessary psychological evaluations, he then harvested female bodies to make a feminine suit. In the novel, it is noted that the character is not actually a transsexual; this distinction is made only briefly in the film.[76]

Although Better Than Chocolate is primarily about the romance of two lesbians, a subplot in the 1999 Canadian film has Judy (Peter Outerbridge), a trans woman with a crush on Frances (Ann-Marie MacDonald), the owner of a lesbian bookstore. Within the film has a few scenes showing how Judy loses her parents who are unable to accept her, and buy her off with a bye forever present in purchasing a home for her.

In television

Transsexual people have also been depicted in popular television shows. In part of the first season of the 1970s t.v. comedy series, Soap, Billy Crystal plays Jodie Dallas, a gay man who is about to undergo a sex change in order to legally marry his male lover, who breaks off the relationship just before the surgery. In Just Shoot Me!, David Spade's character meets up with his childhood male friend, who has transitioned to living as a woman. After initially being frightened, he eventually forms sexual attraction to his friend, but is scorned, as he is 'not her type'. In an episode of Becker Dr. Becker gets an out-of-town visit from an old friend who turns out to have undergone SRS, it plays out very similar to the situations in Just Shoot Me!. In a 1980s episode of The Love Boat, McKenzie Phillips portrays a trans woman who is eventually accepted as a friend by her old high school classmate, series regular Fred Grandy. In the 1970s on The Jeffersons, George's Navy buddy Eddie shows up as Edie and is eventually accepted by George.

Dramas including Law & Order and Nip/Tuck have had episodes featuring transsexual characters and actresses. While in Nip/Tuck the role was played by a non-transsexual woman, in Law & Order some were played by professional cross-dressers. Without a Trace and CSI: Crime Scene Investigation have had episodes dealing with violence against transsexual characters. Many transsexual actresses and extras appeared on the CSI episode, "Ch-Ch-Changes," including Marci Bowers and Calpernia Addams.[80] The trans woman victim, Wendy, was played by Sarah Buxton, a cisgender woman. Candis Cayne, a transsexual actress, appeared in CSI: NY as a transsexual character. From 2007 to 2008, she also portrayed a transsexual character (this time recurring) in the ABC series Dirty Sexy Money.

Hit & Miss is a Drama about Mia, played by Chloë Sevigny, a preop transsexual woman who works as a contract killer and discovers she fathered a son.

Customs and traditions

Transgender Day of Remembrance

The Transgender Day of Remembrance is held every year on November 20. This event is held in honor of Rita Hester (killed Nov. 28, 1998), a victim of an anti-transgender hate crime. TDOR serves a number of purposes:

memorializes all of those who have been victims of hate crimes and prejudice

raises awareness about hate crimes towards the transgender community

honor the lost ones and their relatives by expressing respect for each other[81]

Trans March

The Trans March is one of three protests held in San Francisco, California during "Pride Weekend" during the last weekend of June. Every year people from the transexual community gather in San Francisco, CA to protest social justice and equality for them. In addition, through the march they strive to inspire everyone from the transexual community to come out to an environment where power is shared and where one can feel safe and cared for.
The event also hosts comedians, music, and dancing at the park. After parties are often followed after the event.[82]

Thailand

Transgender researcher and activist Prempreeda Pramoj Na Ayutthaya claims that there is notable discrimination against transexual people in relation to education and job opportunities in Thailand.[83] An article in Bangkok Post in 2013, claims that there is societal discrimination against transsexuals in Thailand.[84] An editorial in Bangkok Post in 2013, said "Yet it is also true that we don't find transgenders as high-ranking officials, doctors, lawyers, scientists, or teachers in state-run schools and colleges. Nor as executives in the corporate world. In short, the doors of government agencies and large corporations are still closed to transgender women. It is why they must be self-employed or work as freelancers."[85] Thai law does not give "post-operation" male-to-female transexual people—who are government employees—the right to wear female uniforms at work.[86]